Exercise Induced Bronchoconstriction
Key Points
Key Points
- The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
- Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
- The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
- The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
- EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
- Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.
Diagnosis
...Diagnosis...
...ary Statement (SS)1: In asthmatic pa...
...s of EIB should be confirmed by demo...
...uate EIB in elite athletes by using objec...
...a standardized bronchoprovocation (exerci...
...5: In subjects with no current clinical...
...Use an indirect graded challenge (eg, mannitol, i...
...S7: Perform an indirect challenge (eg, exe...
...ventilation reached and sustained during...
...S9: Perform EVH as the preferred surrogat...
...rect graded challenge (eg, mannitol) result is...
...To differentiate between EIB and exercise...
...o determine whether exercise-induce...
...Perform spirometry, as well as de...
...ider a diagnosis of exercise-induced anaphy...
Treatment
...T...
...5: Refer to appropriate specialists...
...S16: Refer patients for psychological evaluat...
...: Schedule regular office visits with p...
...β2-Adrene...
...S18: Prescribe inhaled short-acting β2-adrene...
...ibe a single dose of SABA, LABA, or both on an...
...s in daily use of β2-adrenergic agents alone...
...Leukotri...
...sider prescribing daily therapy with leu...
...Mast Cell Stabiliz...
...er prescribing inhaled cromolyn sodium and nedocr...
...ICSs...
...3: Consider prescribing ICSs in co...
...S24: Do NOT prescribe daily LABAs...
Anticho...
...25: Consider prescribing inhaled ipra...
...Nonpharmacolog...
...ribe pre-exercise warm-up for EIB because it...
...der with caution the recommendation of reducti...
...Co...
...hletes with EIB alone in a similar manner...
...igure 1. Algorithm for the Diagnosis, Treatment,...